The healthiest state in these United States? Vermont. The least healthy? Louisiana. That’s
according to the United Health Foundation’s annual report “America’s Health Rankings.” Joining
Vermont in the top five are Hawaii, New Hampshire, Minnesota, and Utah. Joining Louisiana in the
bottom five are, in descending order, Texas, Tennessee, South Carolina, and Mississippi.

So what does Vermont have over Louisiana? Is it something in the drinking water? In the air?
Or is it the mountain views? Actually, it has less to do with nature and more to do with the
actions of the humans who live in those states. Researchers based the rankings on several factors,
including personal behaviors, public health policies, and the availability of good medical care.

Take smoking, for example. Having a higher percentage of smokers lowers a state’s grade,
because smoking contributes to heart disease, lung disease, and cancer. Utah came out on top in
this category, and Kentucky was last, with stiff competition from West Virginia and Oklahoma.

Another indicator is the obesity rate, because obesity often leads to serious medical
conditions, such as diabetes and heart disease. Colorado, 19th overall, was ranked as the state
with the lowest rate of obesity. Mississippi had the highest rate.

But it is not just about what you do to yourself—or for yourself. A state’s state of health
also depends on what its government is doing, says Dr. Paul Jarris, executive director of the
Association of State and Territorial Health Officials. Good state programs “can drive personal
behaviors in the right direction,” notes Jarris, who was also Vermont’s commissioner of health.

Education plays a role as well. Studies show that a higher rate of high school graduates
goes hand in hand with better overall health. Education, of course, depends on school systems and
state funding.

States that make efforts to fight poverty also get a health benefit. The fewer the number of
children living in poverty, the better the health marks overall. “The level of education and a
family’s income are two of the biggest determinants of health,” says Jarris. Other factors are the
availability of prenatal care, the number of primary-care doctors, and greater spending on public
health.

One of the big negatives is lack of health insurance. Texas is No. 1 in the nation for
percentage of uninsured residents, which helped determine its overall ranking at No. 46.
Massachusetts has the highest percentage of people covered, and it’s in the top 10.

Earlier studies found clear links between where you live and how long you live—discovering
patterns even at the neighborhood level. Indeed, some studies link your address with your rate of
surviving a stroke or a heart attack. Predictably, you’re better off living near a hospital with
experience in handling the situation than you are suffering a heart attack in the middle of
nowhere.

“Health is not just what happens at the doctor’s office,” says Jarris. “It happens in the
community.”

Does this mean people should move to one of the “healthier” states to stay in good health?
The truth is, though it may be harder to have access to some services in some states, you can
practice a healthy lifestyle no matter where you live. Exercise, eat well, don’t smoke, and drink
moderately.

While you’re at it, think about what you can do to create a real sense of community, where
people care for each other. Get your kids immunized. Urge the people you know to stay in school.
Lobby for healthy lunches and more physical activity in schools and the workplace. Talk to your
community leaders. Campaign for safer neighborhoods where kids can play and where you can become
physically active.

Who knows? You just might help your state climb a step or two in the rankings.
How They Rank